Thoughts, Bemusements & Arguments

I put up this little item on Facebook recently and it seemed to strike a chord with lots of people. So I thought I’d share it here.

The other day I received an email asking me to answer some questions about leadership in health and social care by a major service provider. I won’t say which organisation sent me this, as that would possibly be unfair and misrepresent their true intentions. However I did find their questions so peculiar, and so unremittingly consumerist, that I felt moved to share the questions I was asked, along with my answers:

Dear John

I’m afraid my answers may not be as useful as you’d like, because I suspect I can’t quite see how to frame the challenge quite like that. But here are my answers to your 6 questions:

Q1: The overarching question we are seeking to address is: “How do we consistently lead and deliver high quality, high impact [services] for people that lives up to the brand?”

A1: If we are too concerned about ‘the brand’ then we should be worried about our underlying values. Moreover, largely brands in our sector are complex and contested. e.g. a brand like the ‘Mencap brand’ is not necessarily a ‘good brand’ to which we’d like people to live up.

Q2: How do effective leaders in health and social care ensure that their staff are customer focussed? (Thinking about all people issues, from recruitment, performance management etc..)

A2: Customer-focus in our sector is a deeply unhelpful way of conceptualising what we are doing and why we do it. People are citizens, not customers. People do not shop for human services and they certainly don’t shop for a life. We build a good life together.

Q3: How do effective leaders in health and social care identify what their customers want?

A3: We explore what we want to achieve in life through a process of internal and real world discovery. You are either on that journey with someone or you are not. There are few effective short-cuts and those there are can come at a high cost to your integrity (e.g. misusing person-centred planning).

Q4: How do effective leaders in health and social care measure their customer’s satisfaction?

QA: I suspect that measuring satisfaction is mostly done for effect. It can be useful as part of showing people the value of an innovation, but in normal circumstances it is fraudulent, as the underlying power relations distort the value of the data. True leaders listen and respond, but mostly they empower others to act. Ideally the last thing they want to do is appear as a ‘leader.’

Q5: How do effective leaders ensure consistent quality across an organisation which may span the country?

A5: Top-down control for quality in human services leads to bureaucracy, elitism and managerialism. Its impact is to rob power from the lives of disabled people and those working closely with them. An effective organisation ‘manages’ by liberating innovators, enabling good practice and dealing urgently with real problems when they arise – learning as transparently as possible as they go.

Q6: How would leadership in an organisation which delivers consistent high quality, high impact for people differ from one where this is not achieved?

A6: Such leaders would show humility, facilitate mature conversations and seek to explore how they can improve things further.

I hope that helps.

Best wishes

Simon John Duffy

I am not sure what else to say. However I think this divide, between seeing each other as citizens, or seeing each others as customers, is fundamental. The customer model obviously connects to many modern trends (positive and negative) but it seems such a fundamentally unhelpful way of thinking about disability and human services. The fact that something seems so obviously right to some, while it seems so obviously wrong to others, is indicative of the profoundly paradigmatic issues at stake. I suspect we won’t be able to just explain our way out of this problem. I think we will need to act as citizens in order to show others what citizenship means and what citizenship can do.